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Clot Burden and Collaterals in Anterior Circulation Stroke: Differences Between Single-Phase CTA and Multi-phase 4D-CTA

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Abstract

Purpose

It has been reported that the extent of intravascular thrombi and the quality of collateral filling in computed tomography (CT) angiography are predictive for the clinical outcome in patients with acute stroke. We hypothesized that multi-phase four-dimensional CTA (4D-CTA) allows better assessment of clot burden and collateral flow compared with arterial single-phase CTA (CTA).

Methods

In 49 patients (33 female; age: 77 ± 12 years) with acute anterior circulation stroke, CTA and 4D-CTA reconstructed from dynamic perfusion CT data were analyzed for absolute thrombus length (TL), clot burden score (CBS), and collateral score (CS). The length of the filling defect was also defined on thin-slice nonenhanced CT as corresponding hyperdense middle cerebral artery sign (HMCAS) when present.

Results

There was good correlation (r = 0.62, p < 0.01) between the length of HMCAS (1.29 ± 0.62 cm) and TL in 4D-CTA (1.22 ± 0.51 cm). 4D-CTA and CTA significantly varied (p < 0.01) in TL (1.42 ± 0.73 cm (CTA) versus 1.11 ± 0.62 cm (4D-CTA)), CBS (median: 5, interquartile range: 4–7 (CTA) versus median: 6, interquartile range: 5–8 (4D-CTA); p < 0.001), and CS (median: 2, interquartile range: 1–2 (CTA) versus median: 3, interquartile range: 2–3 (4D-CTA); p < 0.001). Accordingly, CTA significantly overrated clot burden and underestimated collateral flow.

Conclusions

4D-CTA more closely defines clot burden and collateral supply in anterior circulation stroke than CTA, implicating an additional diagnostic benefit.

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Conflict of Interest

The authors declare that there is no conflict of interest in relation to this article.

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Authors and Affiliations

  1. Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany

    I.N. Kaschka MD, S.P. Kloska MD, T. Struffert MD, T. Engelhorn MD, P. Gölitz MD & A. Doerfler MD

  2. Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany

    N. Kurka MD, M. Köhrmann MD & S. Schwab MD

Authors
  1. I.N. Kaschka MD
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  2. S.P. Kloska MD
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  3. T. Struffert MD
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  4. T. Engelhorn MD
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  5. P. Gölitz MD
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  6. N. Kurka MD
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  7. M. Köhrmann MD
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  8. S. Schwab MD
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  9. A. Doerfler MD
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Corresponding author

Correspondence to I.N. Kaschka MD.

Additional information

Iris N. Kaschka and Stephan P. Kloska contributed equally to this work.

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Kaschka, I., Kloska, S., Struffert, T. et al. Clot Burden and Collaterals in Anterior Circulation Stroke: Differences Between Single-Phase CTA and Multi-phase 4D-CTA. Clin Neuroradiol 26, 309–315 (2016). https://doi.org/10.1007/s00062-014-0359-6

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  • DOI: https://doi.org/10.1007/s00062-014-0359-6

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